I had a full facelift 4 months ago with a famous renowned surgeon. Why do I look worse after my facelift? (photo)

Thank you for your question. You submitted some photos describing you had a full facelift 4 months ago by a world renowned surgeon, and you are concerned you look worse after undergoing the facelift. You state in further detail you are fine with the upper part of the face, but feel the lower part of your face seems to look worse. You describe the corners of the mouth are downturned, feel you still have jowls, you have some fatty pockets resembling the late Marlon Brando, and too much volume in your jaw. You want to go back to your doctor armed with some second opinions.
I can share with you my perspective without the benefit of seeing your preoperative photos, but I think I can understand your concerns with the knowledge and experience I have as a cosmetic surgeon. A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I have been in practice in Manhattan and Long Island for over 20 years. Facelift surgery and solutions for facial aging have been the core of my practice throughout my career. There was a period of my career where I was doing many facelifts in a week to help patients like yourself, so this type of challenge I’m familiar with.
There is an important understanding about facial aging I try to relay to every patient. A lot of people who come to me for a facelift consultation look at me sideways when I tell them they’re not really good candidates for facelifts. I’m not saying that’s the situation with you but, I’ll explain why I’m saying that. It’s important to understand that facial aging has two major factors. One is volume loss, which we have more understanding of than we’ve had in the past. Proportionally, a large percentage of volume loss from facial aging is responsible for much of the concerns people have when they come to a doctor like myself. Volume loss has a lot to do with bone loss, which is the structure and foundation of our facial anatomy, as well as fat, muscle, and soft tissue. There’s a significant element of facial aging from that loss. The second part is loosening or sagging. That element has always been a key part of the surgical approach to facial aging. When I was in training back in the 90s, essentially if it droops, we as surgeons lift it. Not everybody has an isolated issue, and there are different elements of each that contribute to a person’s appearance. I suspect that if you were to compare your before and after photos that any element of sagging addressed by a facelift was probably satisfactorily achieved.
Every surgeon who performs face lifting surgery, world famous or otherwise, who is experienced and knowledgeable will attest to the limitations of lifting based on all the other variables present. Some people have more full faces, some have more thinner faces. When there is enough sagging or jowling, and a lot of laxity or redundant tissue in the neck, then face lifting is the optimal procedure for repositioning, but it doesn't mean it solves everything.
A lot of people come to me who have had facelifts done elsewhere, and I discuss with them the other critical element to a youthful appearance which is volume. In our practice, we have used both as a primary and secondary procedure a process called Structural Volumizing. Structural Volumizing means placement of long lasting hyaluronic acid fillers at the level of the bone. As I stated earlier, bone structure is what diminishes the most. So it makes sense in a situation like yours that once the healing process has settled, volume correction will probably significantly restore a lot of the areas you want to see improved.
In addition to volume, for the issue of the downturn of the mouth, we have to look at your before and after photos for the curve of the mouth before the procedure. You can do something as straightforward as a Botox® outer corner lift, where placement of Botox® at a strategic place to get the outer corners to come up. It’s the relaxing of a muscle called the depressor anguli oris. This soon after a facelift is not the time I would generally recommend that, but I think you can understand that it in the context of what your preoperative appearance was that most likely your surgeon did accomplish what they surgeon wanted. but in addition, there is an opportunity to take care of the volume loss.
When I say patients look at me sideways sometimes when they come to me expecting me to do a facelift, but I tell them they’re a better candidate for Structural Volumizing, it’s based on this knowledge and experience. It just happened the other day when someone came to me who 3 years ago wanted a facelift, and I told them they’re not quite ready for a facelift. They went elsewhere and got a facelift, and then came back to me saying that they were unhappy with the outcome because the real issue was about volume. So for this patient, I’m going to be doing Structural Volumizing.
It’s really about understanding these principles that help give people perspective. When I do a consultation with patients about face lifting, I always point out the areas where there is volume loss. Often people are under the misapprehension that the definitive procedure for all facial aging is a facelift, and if they only do one surgery, that will take care of everything. I explain to them a facelift is good for repositioning, but it doesn't change the need for injectable fillers and other things. Yes, many people want to try to get around that through fat grafting, implants, etc., but it’s a matter of what the surgeon’s personal approach is.  I can tell you as an experienced surgeon that this balancing and synergy has worked out very well in my hands in my practice.
Meet with your doctor to discuss these issues, and I don't think your surgeon in any way did anything detrimental. Hopefully you work together on a strategy to help the other areas I discussed. I hope that was helpful, I wish you the best of luck, and thank you for your question.This personalized video answer to your question is posted on RealSelf and on YouTube. To provide you with a personal and expert response, we use the image(s) you submitted on RealSelf in the video, but with respect to your privacy, we only show the body feature in question so you are not personally identifiable. If you prefer not to have your video question visible on YouTube, please contact us.

It's still too soon to tell what your final results will be. You may still have some swelling, which will slowly resolve over the next several weeks. I do recommend following up with your surgeon about your concerns. I hope this helps. 

Hi there, I am sorry about your experience. Most of the swelling should be gone by now. Judging from your photographs and these are no substitute for clinical examination, you are right to have concerns about your facelift results. You should go and speak with your plastic surgeon to see what what his solutions and thoughts are about your results. Good luck.